The document discusses addressing the shortage of ophthalmologists in Francophone West Africa. There is currently a gap of 167 ophthalmologists across the region to meet population needs. Training programs produce an insufficient number of graduates and many existing ophthalmologists will soon retire. A regional strategic plan was developed through stakeholder consultation to increase the number of surgically skilled ophthalmologists through upgrading training institution infrastructure, equipment, and residency programs. The plan also aims to provide continuing education to existing medical ophthalmologists. Implementing the plan will require a budget of over $9 million with most funds going towards upgrading equipment and facilities across the region.

1. ADDRESSING
OPHTHALMOLOGISTS TRAINING IN
FRANCOPHONE WEST AFRICA
Adidja AMANI, MD, MPH
HR PROGRAMME MANAGER , SIGHTSAVERS
“Skills have become the global currency of the 21st century. Without proper
investment in skills, progress does not translate into economic growth”

2. Outline
Overview The Analysis
of the situation
The Regional
Strategic Plan

3. Overview of the Problem

4. How did we get there?
Nigel
Crisp, the
inspirer
Caroline
Harper,
CEO
Ronnie
Graham,
HRH D
• 10-Year Strategy to respond to
the HReH Crisis in Africa
Objective 4:Meeting the
specific health workforce
challenges in Francophone
and Lusophone Africa

5. Francophone West Africa at a Glance
 16 countries - 8 francophone
 Area=3, 455, 984 km2
 Population of 99, 599, 066 (CIA fact book, 2012)
 Average life expectancy = 53 years
 % of Urban Population = 37% (17-50%)
 the population aged over 50 years will double
during the next 20 years (UNFPA) greater number
of people with visual loss and blindness from
cataract that will need eye services
 Health budgets =5.84%

6. The CSR in Francophone Africa remains<500
CSR AFRO , 2003 CSR AFRO, 2004
SOURCE: Prevention of Blindness and Visual Impairment WHO-AFRO
CSR Global, 2004

7. What is the problem?
 The Escalating Number of avoidable blindness
 Heavy non operated cataract burden in FWAC --
------ >>>> unnecessary losses in productivity
How best can we support FWAC to meet their needs
/the vision 2020 targets?

9. July 2012-
The situational analysis: the process
Goal: generate evidence to
deepen the appreciation of
the challenges and the
opportunities of in the region
 8 Countries

10. 360 degree stakeholder’s consultation…
Benin, Dean and Chief
of department
Senegal, Dean
Cheik Anta Diop
Residents in
ophthalmology
CBM D.O
Cote d’Ivoire
OCO, ON and Chief of
department
Patients at USE Niger with
HR Director, NEEC
Burkina Faso,
Medical council

11. Findings: The Gap
Country Training
program
Population Ophtalomologists
Current Required Gap
BENIN YES 9598787 26 38 18
BURKINA F NO 17275115 27 68 41
COTE
D’IVOIRE
YES 21952053 82 84 2
GUINEE YES 9300000 24 37 13
MALI YES 14533511 34 57 23
NIGER NO 17078839 14 68 54
SENEGAL YES 12969606 54 51 +3
TOGO YES 6191155 18 24 6
Total 279 427 167

12. Who perform eye surgery in FWAC?
Ophthalmologists who reported to perform surgery vs
Medical ophthalmologist
Source: Adapted from WAHO data, 2010
 Cataract surgeons are not really
present nor accepted as a cadre.#IOTA
 TSO= conflicts of competences
 Various eye camps by INGOs “Not
welcomed” : Mercy Ships, Nadi El
Bassar, Islamic relief, etc= “Neither
integrated nor sustainable, they are a
strong disruptor of health system”
 The regions has the lowest % of
surgically-active o’gists (Resnikoff and al., 2012)
Medical
ophtalmolog
ists
44%
Ophthalmolo
gistwho
reported to
perform
surgery
56%

13. .
The number of O’gists in FWAC range from 14 in
Niger to a maximum of 60 in Senegal

14. Findings: Shortage, quality, equipment …
U. of
Lome-
TOGO
12%
UCAD-
SENEGAL
14%
DESSO-
GUINNEE
16%U of
Bamako-
MALI
17%
U. Abomey
Calavi-
BENIN
19%
U of
Coccody-
COTE
D’IVOIRE
22%
53% of the Residents in
ophthalmology do not perform
surgery at all
53%
Training centres for
ophtalomologists
Faculty Cataract
surgery
/10
N. of
functional
wet lab
Max per
batch
Current
batch
Faculté des Sciences de la
Santé of the University of
Abomey Calavi -Benin 5 3 0 N/A 5
Unités de Formation et de
Recherche of the University
of Cocody – Cote d’Ivoire 16 1 0 10 3
Faculty of Medicine,
Pharmacy and
Odontostomatology of the
University Cheickh Anta
Diop in Dakar -Senegal
8 5 1 6 4
Faculty of Medecin and
Pharmacy of the University
of Lome-Togo 3 4 0 4 2

15. 18
in 2013
28
34
in 2015
23
28
in 2017
36
in 2018
1 2 3 4 5 6
N. of graduates
 Projection of the N. of graduates in
ophthalmology in the region /year
 Evolution of the number of post graduates in
ophthalmology in the Francophone West Africa
for the last 40 years
50% are more than 55 years
Retirement rate is up, the production is not enough and the quality of graduates do not meet
the population needs
74 74
75
84
68
70
72
74
76
78
80
82
84
86

16. Priorities are crosscutting:
Strengthen surgical skills and Equipping
Country Priority n°1 Priority n° 2
Benin Upgrade surgical skills for trainees &
o’gists
Start to train TSO’s
Burkina Faso Start training og’ists
upgrade surgical skills for O’gists
Equip health centers
Cote d’Ivoire Upgrade surgical skills for trainees and
o’gists
Equip the training institution and
health centers
Niger Start training og’ists Equip
Sénégal Upgrade surgical skills for trainees Equip the training institution
Togo Upgrade surgical skills for trainees Equip training institution
Mali Training of trainers Equip health centers

17. The Regional Strategic Plan
The Need To Rethink Approaches To Training Is
Not New, But Is Becoming URGENT

18. • Training institutions: Dean, Chief of Department of ophthalmology
• MoH: Human Resources Directors, NECC of 8 countries
• INGOS: Nadi El Bassar, CBM, HKI,OPC
• WHO, WAHO, Independent consultant
NOV 2012 OPEN & INCLUSIVE consultation with 52 stakeholders

19. The strategic plan
The goal: produce surgically skilled ophtalomologists well
equipped to address eye health challenges
1. Increase the number of surgically skilled ophthalmologists at
the regional level( Residency program, medical o’gist CPD)
2. upgrade and scale up the infrastructures of the training
institutions
3. Upgrade the equipment and training materials for all the
training institutions and for their university teaching hospital
4. mobilize resources and coordinate the implementation of the
regional strategic plan

20. “Erasing red dividing line” between training and Needs
 Accreditation of non-academic high volume surgery centres for internships of
residents
 Post trainees in high volume centers like Dabou, IOTA ,Bopp,Gléï, CADESSO
 CPD for medical ophtalomologists
 upgrade the infrastructures of training institutions and
 Upgrade the equipment and training materials for all the training institutions
and the university teaching hospitals
 Train domestically (Niger and Burkina Faso)
 Equip residents  improve the productivity and retention
 Regionalize areas of sub specialization (Paediatric ophthalmology)
according to the relative endowment of individual institutions

21. Better Skills, Better Lives
COUNTRIES COSTS
GUINEE £ 76,984
CROSS CUTTING ACTIVITIES £ 291,005
MALI £ 506,613
BENIN £ 507,275
SENEGAL £ 515,211
COTE D'IVOIRE £ 836,068
TOGO £ 1,012,566
NIGER £ 1,136,243
BURKINA FASO £ 4,412,698
TOTAL £ 9, 294, 663
 There is a need, and the
potential to do things
differently
 Do more with less by
integrating useful skills
 Avoid costly medical
evacuations
 However, the successful
delivery of these interventions
will require broad-based
partnerships

22. “Massive scaling up = Massive funding”
On trainees
9%
On trainers
14%
CPD for
medical
ophtalmologist
4%
Equipment and
Upgrading
63%
Construction
and extension
7%
Advocacy,
M&E,etc
3%Other
10%
Where will the money go?
NIGER
12%
COTE
D'IVOIRE
9%
SENEGAL
6%
TOGO
11%
BENIN
6%
BURKINA
FASO
49%
MALI
6%
GUINEE
1%
Budget By Country

23. Half full
Half
empty

24. The elimination of avoidable in blindness in
FWAC is within our grasp. When it is achieved,
it will be a major public health triumph.
What is stopping us?